By Gina Shaw“See one, do one, teach one.”
For years, that has been the mantra of residency education. Interns and residents move from the protected atmosphere of medical school into the hurly-burly of residency, where they learn new procedures and skills by watching more senior residents and then take on the teaching role themselves as younger graduates move up. But when do they actually learn to teach? For the most part, newly minted medical school graduates enter their residencies with little, if any, experience or instruction in pedagogy, and not all are naturally good at teaching. Medical students have increasingly become interested in developing a teaching competency, so P&S has become part of a leading wave of medical schools with programs designed to teach students to teach.
The largest organized program that offers such teaching opportunities at P&S is “Back to My Classroom,” launched by Marc Dickstein, M.D., course director for Science Basic to the Practice of Medicine (SBPM), and Abigail Ford’06, a student at the time and now an obstetrics/gynecology resident at Columbia. Structured in a case-based format, this elective allows fourth-year students to share what they’ve learned with first-year students by leading small groups in discussion of cases relevant to the SBPM curriculum. They also teach clinical skills such as blood pressure measurements, basic ECG interpretation, and physical exam.
The program began in 2004 with about 30 fourth-year students; for the 2008-09 year, Dr. Dickstein and student leaders of Back to My Classroom have recruited more than 60 “teachers.” A number of them, including the program’s leaders, are staying for their fifth year of medical school after taking a year off for research or other educational opportunities.
A letter from rising fourth-year students Benjamin Kennedy, Maxwell Merkow, and Katie Greenzang to prospective participants summed up the program this way: “Fourth years have a great wealth of experience for which first years are hungry, and fourth years are in a unique position to excite and inspire new medical students,” they wrote. “But wait, you also receive as you give! [Back to My Classroom] is a phenomenal opportunity to learn about teaching, both experientially in the classroom and in monthly meetings in which we have educational experts and strong clinical teachers come in for talks, panels, or Q&A sessions about all aspects of teaching.”
During his year off during the 2007-08 academic year to do cancer research, Ben Kennedy taught classroom sessions and helped to organize Back to My Classroom. He’s returning to participate more extensively this year and calls the experience “one of the most valuable I’ve had in medical school.”
Mr. Kennedy still recalls his first case-based lesson in Back to My Classroom. “There were about four of us presenting on infectious diarrhea, and we had put together some silly PowerPoint slides to break the ice,” he says. “The students had probably never heard a case presentation before, and we said, ‘This is how you’ll be learning medicine, to a large extent, for the rest of your life.’ And since GME (graduate medical education), from what I’ve seen on the wards, is very similar to what we’re doing in this class, it’s also preparing us for the way that we’ll be presenting and educating each other for the rest of our careers.”
Although Back to My Classroom may be the largest organized effort at P&S to actively teach students to teach, it is not the only opportunity. The Student Success Network (SSN), which has been active at P&S for more than 15 years, provides academic support for first-year students via small-group exam review sessions and tutoring facilitated by second-year students who “know what to learn and remember how to learn it.”
When it was created in 1991, SSN had as its primary goal “to eliminate unnecessary failure,” says the program’s founder, Mindy Fullilove, M.D., professor of clinical psychiatry and sociomedical sciences in public health. “SSN was based on a program at U.C. Berkeley, which was based on the idea that you really learn something by teaching someone else. So once the leadership of SSN had solved the basic problem of preventable course failures, they pursued other initiatives, including teaching to teach, by creating things like a teaching guide and a teacher training module done at the beginning of the school year.”
“SSN was very much a groundbreaking organization in medical schools,” says Megan Jessiman, Ph.D., a member of the Class of 2011 and the program’s coordinator. As a student-run organization that serves students, it anticipated the move toward peer teaching. “Our priority is always the academic well-being of the first years but we pay close attention to the SSN staff’s development as educators. This year we’ll provide the opportunity for more than 70 second years to reflect on their teaching and to improve it as the year progresses.”
Dr. Jessiman and Dr. Ford also have worked with the Center for Education Research and Evaluation (CERE) to develop a dialogue among medical students and residents on teaching. PRACTICE (P&S students and NYP residents conversing about teaching in the context of medical education and practice) hosts weekly meetings that students and residents can attend as their schedules permit. “We want to develop a sustained, open-ended conversation that will permit people to reflect on both the teaching experiences they’ve had and their experiences as learners,” says Dr. Jessiman. “We hope to view the development of learning and teaching skills as more of a seamless process, as opposed to one where medical students become extremely good at being students only to discover, upon graduation, that residency demands teaching skills.”
Boyd Richards, Ph.D., CERE’s director, praises the initiative P&S students have taken in Back to My Classroom, SSN, PRACTICE, and other programs. “The thing that impressed me in coming here is the enthusiasm students have about teaching and how much they want to be involved in the process of teaching their peers,” he says.
A perfect example of this is the clinical correlation elective. Launched by Paul Lee, M.D., director of the hospitalist program and associate director for the medical house staff training program at NewYork-Presbyterian, in 2000 when he was a senior resident, it is organized and run by fourth-year students. Fourth-year students take second-year students to patient floors and show them the relevance of what they are learning in the classroom. Most of the fourth-year students take on this task for the love of education and teaching, because it offers no course credit.
“Usually there are about 14 fourth years involved in a given year,” says Dr. Lee. “They are put into pairs and run one or two sessions per week, and they find patients that are clinically relevant to what the second years are learning that week. Then they lead them through a very directed history-taking and a very directed physical exam and continue the discussion outside the patient’s room afterward.”
Each pair must take one clinical topic and repeat it at least four times that month  four different patients but the same essential topic. “They learn through repetition that every group of students behaves differently,” says Dr. Lee. “And they see that bedside teaching is very different from classroom teaching.”
Students in these electives are also helping to advance pedagogical research. For example, “Attending Physician and Medical Student Perception of Medical Jargon in Bedside Presentations,” a research project conducted by three successive years of students in the elective (Eva Turek’06, Peter Chung’07, and David Shen’08), produced an abstract that won the medical education category at the 2008 American Medical Student Association conference.
Much of the discussion about teaching residents to teach has taken place at the residency level, says CERE’s Dr. Richards. “The national effort to look at programs for residents as teachers only now seems to be trickling down to the medical school level. But wouldn’t it make sense to have this become more of a part of the medical school curriculum? With P&S now in the process of curricular reform, I think this could play an important role.”
Most students agree. Katie Greenzang’09 was one of the first to go through the Back to My Classroom program as a first-year student. “Fourth years have a better sense of what it feels like to know nothing, what it is a first-year student might know and not know, than someone who’s been practicing for 40 years.”
Ms. Greenzang, who spent the past year completing a master’s degree in education, looks forward to implementing what she’s learned, such as teaching by the case method. “I hope to provide the first years with a lot of the things I gained from Back to My Classroom: the language of medicine and the excitement of how what you’re learning will connect down the line. What can sometimes seem like discrete medical facts that don’t connect can in fact be organized into what you’ll see in living, breathing patients.”